Exploring and enhancing community awareness on antimicrobial resistance: perspectives from world antimicrobial resistance awareness week celebration in Ghana

Abstract

Background

Antimicrobial resistance (AMR) is an escalating health crisis, particularly in low- and middle-income countries (LMICs) where limited healthcare infrastructure and weak regulations contribute to the misuse of antibiotics. Many people unknowingly fuel this resistance by misusing antibiotics, whether for common colds or other viral (non-bacterial) infections. To address this challenge, we conducted a study to understand how communities perceive antimicrobial resistance (AMR) and their use of antibiotics.

Methods

As part of the World AMR Awareness Week (WAAW) in Ghana, we conducted an exploratory, quasi-experimental, mixed-method study design to assess the knowledge, attitudes, and practices of communities related to AMR. The study was conducted at four sites across rural and urban settings: St. Martin Catholic Hospital (Agroyesum, Amansie-South District), St Francis Xavier Hospital (Assin Foso, Assin Foso Municipal District), University Junction Taxi Terminal (Ayigya), and Kumasi Metropolis. We surveyed 102 participants before (pre-engagement) and after (post-engagement) targeted educational activities, exploring their familiarity with antibiotics, awareness of AMR, and changes in perception following the sensitisation sessions.

Results

Pre-engagement, 88% of participants were familiar with antibiotics, and 77% were aware of AMR; significant knowledge gaps persisted. Alarmingly, 21% believed antibiotics can treat viral infections and 64% reported antibiotic use in animal farming. Only 14% acquired antibiotics via formal healthcare, while 53% of the participants found them “very easy” to obtain. A substantial 45% reported personal experience of antibiotic therapeutic failure. Post-engagement of the educational activities, all participants demonstrated fair awareness of the concepts of antibiotics and AMR quantitatively (via closed-ended questions) and qualitatively (through more precise open-ended definitions), with increased confidence and improved understanding. A high proportion (91%) of this population also perceived AMR as a healthcare challenge, and 95% of them recognised antibiotic misuse.

Conclusion

These findings revealed prevalent misconceptions and informal antibiotic acquisition channels in Ghana. The study demonstrates that targeted community engagement is a promising strategy for improving AMR knowledge and fostering responsible antibiotic use, highlighting the urgent need for multi-stakeholder, “One Health” approaches beyond traditional clinical settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-26385-6.

Introduction

Misuse and overuse of antibiotics have led to the emergence and spread of antimicrobial resistance (AMR) in bacteria, which is now a global public health concern [1]. The World Health Organisation considers AMR as one of the top 10 global public health threats [2]. It is estimated that by 2050, if no effective action is taken, about 10 million AMR-related and/or associated deaths will occur annually, along with severe economic burden and other global consequences [3, 4]. An increase in resistance in these microorganisms is also linked to the widespread and often unregulated use of antibiotics, particularly in community settings where oral treatments are readily available [5, 6]. This uncontrolled access and use can significantly complicate efforts to implement effective antimicrobial stewardship measures [7].

This multifaceted and intricate problem of AMR is particularly prevalent in low- and middle-income countries (LMICs) such as Ghana [8]. These countries often exhibit all the elements that facilitate the spread of AMR, including overburdened healthcare systems, limited access to diagnostics, overcrowding, poor access to clean water and sanitation, and weak regulatory frameworks governing antibiotic use [9]. Additional contributing factors include low public awareness, inadequate microbiological research capacity, and the paucity of data to inform policy and practice [3, 10].

In Ghana, AMR is becoming a growing concern, driven not only by inappropriate antibiotic use in humans but also due to its uncontrolled application in farming and the environment, making the problem even more difficult to contain [11]. The non-judicious use of antimicrobials (including antibiotics) in agriculture significantly contributes to the regional burden of resistance [12].

Several studies in Ghana have reported high levels of bacterial resistance against commonly used antibiotics such as cotrimoxazole (73%), chloramphenicol (75%), ampicillin (26–76%), and tetracycline (80–82%) [7, 13, 14]. This resistance has been associated with several infectious diseases, including gonorrhoea, typhoid fever, sepsis, urinary tract infections, and pneumonia, caused by pathogens such as Neisseria gonorrhoeae, Salmonella typhi, Escherichia coli, Staphylococcus aureus, and Klebsiella species [3, 10, 15, 16]. Key factors contributing to this challenge include inappropriate prescription and dispensing practices, patients’ non-compliance with antibiotic treatment, and the circulation of substandard antibiotics [7]. Furthermore, the widespread practice of self-medication with antibiotics remains a major driver of the rising prevalence and spread of AMR across the country [17].

Education and public awareness are among the primary tools in the global response to AMR, leading to behavioural change at both individual and community levels [18]. However, designing promising educational interventions to combat AMR at the community level in Ghana requires an understanding of public perceptions on antibiotics, their use, and resistance [19]. Rural and informal urban settlements in LMICs are hotspots for antibiotic misuse and overuse [20]. These areas are often characterised by limited or poor knowledge of antibiotics and AMR, which significantly contributes to their inappropriate use. Studies conducted in communities across the Greater Accra and Northern regions of Ghana showed significant knowledge gaps on AMR among the population, which directly influences the misuse of antibiotics and the acceleration of resistance [21, 22]. Community engagement has proven to be a promising and sustainable approach in promoting the knowledge of AMR as well as improving attitudes and practices towards better use of antibiotics, especially in LMICs such as Ghana, Bangladesh, Nepal and Vietnam [21, 23–26]. Evidence suggests that community-based engagement strategies can lead to measurable reductions in behaviours that contribute to the development and spread of AMR [27]. To build on this evidence, and as part of activities marking the World AMR Awareness Week (WAAW) promoted by WHO, we conducted a community-based study in selected rural and urban settings in Ghana; specifically at St. Martin Catholic Hospital (Agroyesum, Amansie-South District), St Francis Xavier Hospital (Assin Foso, Assin Foso Municipal District), University Junction Taxi Terminal (Ayigya), and Kumasi Metropolis; to assess public knowledge and perceptions of AMR.

Aim of study

1. We addressed the existing knowledge gaps through targeted educational interventions employing community engagement.

2. We evaluated the perspective of community members on AMR and antimicrobial stewardship and.

3. Assessed the effect of sensitisation activities on improving awareness, attitudes, and understanding of AMR.

Methodology

Study design

The study was conducted in November 2024 as part of activities commemorating the WAAW celebration. The study had an exploratory, quasi-experimental, mixed-method design (quantitative and qualitative), integrated within community engagement and sensitization programs. Two structured questionnaires were developed by the study team and administered to participants for data collection before and after the community engagement and sensitisation campaigns. The study questionnaire (Additional file 1) was adapted from questionnaires used in previously published studies [28–30].

Study sites

The study was conducted at four community centres/facilities across three municipal districts in two regions of Ghana, (i) St. Martin Catholic Hospital, Agroyesum in the Amansie-South District, (ii) St Francis Xavier Hospital, Assin Foso (Assin Foso Municipal District), (iii) University Junction Taxi Terminal, Ayigya, and (iv) Kumasi Metropolis of Ghana.

Study population

A total of 102 participants were recruited across all study sites, using a convenience sampling method. Therefore, we included all participants present for the World Antimicrobial Resistance Awareness Week celebration held in the four study areas, who consented to being included in the study. The participants represented a diverse mix of demographics, professions, and educational backgrounds, allowing an inclusive evaluation of community-level perceptions. Non-consenting participants were excluded from the study. Both qualitative and quantitative data was collected from this same group of participants.

Data collection

Data were collected using paper-based questionnaires (which comprised quantitative and qualitative components) administered to participants before and after the sensitisation activities (Additional file 2). Responses were later converted to electronic versions for analysis. Pre-engagement questionnaires were issued to assess participant knowledge and use of antimicrobials prior to the WAAW celebrations and education while the post-engagement questionnaires assessed participant knowledge and use of antimicrobials after the educational activity. The two questionnaires were administered within 4 h of each other. Data were verified by double data entry. For this, all questionnaires were entered independently by two trained data clerks and compared for discrepancies. The questionnaires were administered in English, and local translators from the research team assisted participants requiring translation into local languages.

Ethical considerations

Participation was voluntary, and informed consent was obtained prior to data collection. Participants were also assured of confidentiality. To ensure this, personal identifier records (such as name and ID numbers) were not taken from participants. Ethical approval was also obtained from the Committee on Human Research, Publications and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana, as part of the ongoing Expand AMR project (approval number CHRPE/AP/094/23). All procedures performed in this study were in line with the ethical standards of the CHRPE and with the Helsinki declaration.

Data analysis

Response from paper questionnaires were manually entered into Microsoft^® Excel 2023 and subsequently analysed using STATA^® software (College Station, TX: StataCorp LP), GraphPad Prism^® (GraphPad Software, Inc., La Jolla, CA, USA), and VOSViewer^®.

Descriptive statistics, including frequencies and percentages, were used to describe categorical variables such as gender, age group, and other responses from participants. Chi-square test of association was used to assess correlations between demographic parameters and antibiotic use. For the qualitative components of the survey, text mining functionality was employed using VOSViewer to extract, construct, and visualise co-occurrence networks of key terms from open-ended responses. This approach enabled the identification of thematic patterns and insights within participants’ qualitative feedback.

Results

Sociodemographic features of the study population

A total of 102 participants from diverse backgrounds were enrolled in the study (Table 1), with a 100% response rate. Participants were between the ages of 20–76, with a mean age of 33 (± 10.1) years. Most of the participants were in the 20–29 (40%) age group, while the smallest group (1%) were aged 70–79 years. Most participants were from Assin Foso (31%), followed by those from Kumasi Metropolis (25%). Males constituted 61% of the participants, while females made up the remaining 39%. The vast majority of participants (79%) came from the formal (structured employment with regulated training and remuneration) sector, with most being health workers (58%).

Table 1.

Sociodemographic characteristics of participants in this study at the 2024 world antimicrobial awareness week

Variable	No. (%)
Age (Years)
Ranges
20–29	41 (40)
30–39	39 (38)
40–49	15 (15)
50–59	4 (3.9)
60–69	2 (2.0)
70–79	1 (1.0)
Study area
Agroyesum	22 (22)
Assin Foso	32 (31)
Kumasi	26 (25)
Ayigya	22 (22)
Gender
Female	40 (39)
Male	62 (61)
Occupation
Academic/Lecturer	1 (1)
Actuary	1 (1)
Craftsman	1 (1)
Driver	16 (16)
Health worker (Doctor, PA*, Nurse, Midwife, MLS*, etc.)	59 (58)
Researcher	1 (1)
Student	19 (19)
Trader	4 (3)
Category/sector of occupation
Formal**	81 (79)
Informal***	21 (21)
Total	102 (100)

*PA Physician Assistant, MLS Medical Laboratory Scientist

**Formal = Academic/Lecturer, Actuary, Health worker, Researcher, Student

***Informal = Craftsman, Driver, Trader

Pre-engagement assessments

Participants’ knowledge and history of antibiotic use

Prior to the community engagement, 88% of participants reported having adequate knowledge of antibiotics, their purpose and mode of use. When asked about their primary source of knowledge on antibiotics, 71% of participants identified schools as where they first learned about them.

In terms of antibiotic usage, 97% of respondents reported having used antibiotics at some point; over 70% stated that they had been using antibiotics for more than six years while 54% indicated use within the six months prior to the engagement. Most participants obtained antibiotics through hospitals, pharmacies or over-the-counter medicine sellers; and 53% reported that acquiring antibiotics was very easy (Table 2).

Table 2.

Pre-engagement assessment of participants’ knowledge and use of antibiotics

Variable	No. (%)	Variable	No. (%)
Knowledge of antibiotics		Previous use of antibiotics
Yes	90 (88)	Yes	99 (97)
No	12 (12)	No	3 (2.9)
Length of knowledge of antibiotics (years)		Latest use of antibiotics
2–5	18 (20)	< 6 months	53 (54)
6–10	27 (30)	7–12 months	12 (12)
11–20	27 (30)	1–5 years	21 (21)
> 20	17 (19.10)	6–10 years	8 (9)
No. of sources of knowledge of antibiotics		> 10 years	4 (4)
Single	57 (63)	Was the antibiotics then used prescribed?
Multiple	34 (37)	Yes	82 (84)
Source of knowledge of antibiotics		No	16 (16)
School	65 (71)	Ease of acquiring antibiotics
Health worker (Doctor/Pharmacist/Nurse)	30 (33)	Very easy	52 (53)
Family/Friends	5 (6)	Easy	25 (25)
Media	3 (3)	Moderate	17 (17)
Place of obtaining antibiotics		Difficult	4 (4)
Hospital/Pharmacy	83 (84)	Very difficult	1 (1)
Over-the-counter medicine sellers	15 (15)
Left-over antibiotics from previous prescriptions	1 (1)

From the list of antibiotics presented to the participants as a guide, amoxicillin was the most recognised among participants, with 78% reporting that they were familiar with it, followed by metronidazole (53%) and ciprofloxacin (32%). In contrast, gentamycin and secnidazole were among the least recognised antibiotics, as shown in Fig. 1.

Fig. 1.

The 12 most common antibiotics familiar to the study participants (A), and density of antibiotics used by the study participants (B), prior to the educational community engagement

Participants’ knowledge of antimicrobial resistance

Most participants (77%) were aware of AMR, with most attributing their knowledge to school-based education (81%). Interestingly, 45% of the respondents reported personal experiences of perceived therapeutic failure while using antibiotics – a potential indicator of AMR. Among the antibiotics reported as not working, amoxicillin (50%) and ciprofloxacin (24%) were the most frequently mentioned. These instances were noted not only in bacterial infections (41%) but also, alarmingly, in cases of cold or flu (24%).

When assessing participants’ knowledge of antibiotics in relation to AMR, the majority correctly identified antibiotics as most appropriate for treating bacterial infections (78%) and chronic wounds (37%). However, significant proportions of respondents believed that antibiotics were used in treating cold/flu (21%) and digestive discomfort (19%). Participants also reported witnessing antibiotics being used actively in other activities, especially in animal farming (64%) and water treatment (23%) (Table 3). These were self-reported observations.

Table 3.

Participant knowledge and practices regarding AMR prior to educational activities

Variable	No. (%)	Variable	No. (%)
Previous knowledge of AMR (n = 102)		Main use of antibiotics (multiple) (n = 102)
Yes	79 (77)	Bacterial infections	80 (78)
No	23 (23)	Chronic wound	38 (37)
Source of knowledge of AMR (multiple) (n = 79)		Cold/Flu	21 (21)
School	64 (81)	Stomach upset	19 (19)
Doctor/Pharmacist/Nurse	11 (14)	Ailment for which antibiotic seemed to not work (multiple) (n = 45)
Media	2 (3)	Bacterial infection	19 (42)
Family/Friends	2 (3)	Cold/Flu	11 (24)
Antibiotics not seeming to not work on participant/relative (n = 102)		Stomach upset	9 (20)
Yes	46 (45)	Urinary tract infection	2 (4)
No	56 (55)	Bloodstream infection	2 (4)
Name of antibiotic seeming to not work on participant/relative (n = 46)		Enteric fever	1 (2)
Amoxicillin	23 (50)	Skin infection	2 (4)
Ciprofloxacin	11 (24)	Use of antibiotics in other sectors (multiple) (n = 102)
Metronidazole	6 (13)	Animal farming	65 (64)
Erythromycin	2 (4.4)	Plant farming	14 (14)
Amoxiclav	1 (2.2)	Sanitation	18 (18)
Ceftriaxone	1 (2.2)	Water treatment	23 (23)
Cefuroxime	2 (4.4)
Prescription of antibiotic (n = 46)
Yes	35 (76)
No	11 (24)

Analysis of participants’ independent definitions of antibiotics revealed a variety of perspectives. To systematically organize these responses, VOSviewer was used to cluster key terms into five main thematic groups, each represented by a different colour (red, green, blue, cyan, and purple). The size of each cluster reflects the frequency of keyword usage, with larger clusters indicating more commonly used terms.

The Red Cluster (most prominent) included terms such as bacterial infection, bacterial species/group, and antimicrobial treatment. This cluster captured the dominant view of antibiotics as agents used to treat bacterial infections, with frequent associations to medications or drugs targeting groups of bacteria. Cyan Cluster contained keywords like medication and infection, reflecting participants’ understanding of antibiotics as medications used to treat infections, often broadly associated with microorganisms or disease groups. Blue Cluster focused on the inhibitory role of antibiotics, with keywords related to the prevention or suppression of bacterial growth and the treatment of bacterial diseases. Green Cluster represented responses that clearly and succinctly defined antibiotics as drugs or medicines. Lastly, purple Cluster captured interlinking terms that connected the concepts of antibiotics and disease more generally.

This clustering illustrates a range of participant interpretations, with the most frequent and accurate interpretations aligning antibiotics with the treatment or inhibition of bacterial infections (Fig. 2).

Fig. 2.

Participants responses to their definitions of antibiotics, pre-engagement in the educational activities

Correlation between socio-demographic factors and knowledge/length of antibiotics use

We investigated the possible correlation that existed between respondents’ gender, study area, nature of employment (career), and their exposure to and use of prescribed antibiotics as well as knowledge of AMR. The results indicate no significant association between antibiotic use and gender, residence, or occupation (p > 0.05). However, a significantly higher proportion of individuals from peri-urban areas like Ayigya (64%) reported first learning about antibiotics within the past 10 years; indicative of how setting (p = 0.003) and occupational exposure (p = 0.004) possibly affects knowledge and usage of antibiotics. It was also noted that more females (87%) than males were aware of AMR before the engagement in our educational activities even though this was not statistically significant (Table 4).

Table 4.

Sociodemographic features and antibiotic/AMR knowledge

Variable	Use of prescribed antibiotics (%)			Length (years) of knowledge of antibiotics (%)					Knowledge of AMR before engagement (%)
	Yes	No	p-value	0–5	6–10	11–20	> 20	p-value	Yes	No	p-value
Gender
Male	78.9	21.1	0.314	30.3	24.2	21.3	24.2	0.142	62.5	37.5	0.004
Female	86.7	13.3		14.3	33.9	35.7	16.1		87.1	12.9
Study area
Agroyesum	95.2	4.8	0.128	22.7	13.6	27.3	36.4	0.003	90.9	9.1	0.105
Assin Foso	71.9	28.1		30.8	15.4	46.2	7.6		65.6	34.4
KNUST	88.0	12.0		15.7	31.6	31.6	21.1		73.1	26.9
Ayigya	85.0	15.0		9.1	63.7	13.6	13.6		50.0	50.0
Career
Formal	83.5	16.5	0.944	20.5	30.8	30.8	17.9	0.004	75.3	24.7	0.309
Informal	84.2	15.8		18.1	27.3	27.3	27.3		85.7	14.3

Post-engagement assessments

Participants’ knowledge of antibiotics

Following the educational engagement, all participants reported awareness of antibiotics, with 54% expressing high confidence in their knowledge. Additionally, 82% recognised that appropriate antibiotic use is as important as obtaining a diagnostic test, receiving a prescription by a qualified clinician or pharmacist, and strict adherence to prescribed dosage (Table 5).

Table 5.

Participant knowledge of antibiotics, post-engagement of the educational activities

Variable	n (%)
Knowledge of antibiotics, post-engagement
Yes	102 (100)
No	0 (0)
Level of confidence in knowledge of antibiotics
Very confident	55 (54)
Moderately confident	45 (44)
Not confident	2 (2.0)
Ideal measures for antibiotic use
After testing at a hospital and receiving a prescription from a qualified clinician/pharmacist	84 (82)
Not sure	18 (18)

Participant knowledge of antimicrobial resistance post-engagement

All participants expressed an understanding of the concept of AMR after engagement, with about 70% of them expressed high confidence in the knowledge acquired from the interactions. Also, post-engagement, up to 91% of participants recognised AMR as a challenge in healthcare, with 95% agreeing that antibiotics are widely misused (Table 6).

Table 6.

Participants’ knowledge of AMR, post-engagement

Variable	n (%)
Knowledge of AMR, post-engagement (n = 102)
Yes	102 (100)
No	0 (0)
Level of confidence in knowledge of AMR (n = 84)
Very confident	59 (70)
Moderately confident	24 (29)
Not confident	1 (1)
Perception of AMR as a healthcare challenge (n = 79)
Yes	72 (91)
No	7 (8.9)
Perception of antibiotics being misused/abused (n = 66)
Yes	63 (95)
No	3 (4.5)

Discussion

This community-based study was conducted across four major rural and urban communities in Ghana and received a diverse range of responses from participants of various age groups, genders, and occupational backgrounds. The findings underscore the relevance of the discourse surrounding AMR and antimicrobial stewardship, reinforcing its recognition as a global health concern [4, 31, 32]. The Ghana National Action Plan on Antimicrobial Resistance Ghana has adopted a multi-sectoral approach that recognizes that solutions require coordinated action across all sectors; including local communities.

Understanding AMR is therefore fundamental to addressing its burden, as poor knowledge of antibiotics and their appropriate use has been consistently linked to a higher risk of AMR, particularly in low- and middle-income countries such as Ghana [33]. Studies have shown that inappropriate antibiotic use is often associated with inadequate formal training and/or education [31, 34]. Therefore, it is not only essential to be aware of antibiotics but also to possess accurate knowledge on their appropriate use and methods of acquisition [35]. Consistent with these trends, our findings indicate that participants with lower levels of formal education were more likely to report prolonged antibiotic use beyond the prescribed duration. This pattern may reflect differences in access to antibiotics—particularly through over-the-counter medicine and chemical sellers who frequently dispense antibiotics without prescriptions—as well as less regulated patterns of use. These observations align with previous studies linking lower educational attainment to inappropriate antibiotic use [36]. A higher proportion of female participants demonstrated awareness of AMR, likely reflecting the social structure of Ghanaian communities where women are predominantly the care-givers, especially in situations of ailment and ill-health and are therefore more frequently exposed to health-related information [37]. This makes it imperative that future AMR campaigns could possibly target females/women in AMR and antimicrobial stewardship (AMS) sensitization campaigns and education; as the underlying social structure may mean that they can be better ambassadors and safeguards of antibiotics.

In low-resource settings, studies have shown that access and regulation surrounding antibiotics is relatively low, as efforts are often channelled more towards the provision of basic healthcare needs of society [15, 32]. Little attention is expended on knowledge, education, and advocacy on AMR and AMS. Although our findings revealed little gender-related discrepancy in overall feedback, the data suggest that AMS interventions should target entire communities, irrespective of gender associations, as education and behavioural patterns such as adherence to prescription and self-medication are more implicative factors for AMR and AMS. Also, the small sample size of the study may make it difficult to generalize findings from this study nationally.

Findings from this study further highlight significant gaps in antibiotic knowledge and usage patterns within local populations, especially in West Africa, most of which were previously unknown [15]. While it is encouraging that most respondents were familiar with antibiotics and reported using them based on prescription, which is consistent with studies in other parts of the sub-Saharan region [38], inappropriate use remains widespread. Approximately 21% of participants reported using antibiotics for treatment of viral infections such as cold/flu, and 23% reported using them for water treatment, both practices that contribute significantly to AMR. These behaviours are compounded by participants’ experiences of antibiotic seemingly of low effect, with amoxicillin and ciprofloxacin being the most implicated drugs. Similar patterns have been documented in other studies across the region, where overused first-line antibiotics, such as amoxicillin and amoxicillin-clavulanate, are frequently associated with high levels of bacterial resistance [15, 31]. Underlying these behaviours are systemic weaknesses in antibiotic regulation, including poor implementation of national AMR action plans, weak political commitment, rampant over-the-counter and informal drug sales, and reliance on undertrained drug dispensers, as reported in countries such as Ghana, The Gambia, Nigeria, and Kenya [33, 39–41]. These challenges emphasise the urgent need for more robust AMS programs that are context-specific. Furthermore, these findings call for in-depth studies to explore the predictors of inappropriate antibiotic use in community settings. Such research would be essential to inform evidence-based, context-specific interventions and policy actions that strengthen AMS and contribute to the global fight against AMR.

It is worth noting that while most reported using prescribed antibiotics, 14% of the respondents still reported obtaining antibiotics through informal healthcare providers. This is still very significant in the context of antimicrobial resistance and stewardship. This finding suggests a gap in the regulation of antibiotic access and use. A contributing factor may be the suboptimal dispensing practices of antibiotics and access to them, which often occur with minimal oversight [42, 43]. These findings also draw attention to the apparent shortcomings of health facilities and healthcare practitioners as important channels for education on AMR and for implementing community-based AMS strategies. This aligns with global reports highlighting the dual role of healthcare providers in both disseminating knowledge and contributing through improper practices to the challenge of AMR [31, 44]. Similar observations have been reported in studies conducted in comparable regions across Africa [44, 45], where health system inefficiencies and a lack of patient education persist. Yet, healthcare professionals, particularly doctors, nurses, and pharmacists, are central to AMS, as they are at the frontline of prescribing and dispensing medications [15]. Their interactions with patients present critical opportunities to influence responsible antimicrobial use.

Given this context, it may be important for health policymakers to prioritise mandatory antibiotic education at the point of care. This should include information on the mechanism of action of prescribed medications, the risks associated with inappropriate antibiotic use, the concept of AMR, and the importance of AMS strategies. Importantly, such educational interventions must also extend to other key players in the antibiotic distribution chain, including caregivers, over-the-counter medicine vendors, and drug distributors. Strengthening these linkages will help ensure a more holistic and sustainable approach to tackling AMR within communities. These efforts are likely to yield positive outcomes, as evidenced by the results of this community engagement study, where up to 98% of participants reported feeling more confident in their understanding of AMR and its associated practices. In Ghana, the findings of this study may be a sounding call for the re-enactment of the national action plan for antimicrobial use as a measure of safeguarding antibiotics from misuse and abuse [46]. There can also be exploitation of digital traditional and/or social media channels as complements to face-to-face engagements and education on AMR as this is fruitful in other jurisdictions [47].

The AMR challenge in Africa calls for multifaceted strategies that are specifically tailored to low-resource, highly communal settings like Ghana. Meaningful approaches must include robust community engagement, the revitalisation of community-based surveillance systems, and comprehensive education for both healthcare providers and recipients within the community. Such context-specific strategies have demonstrated success in related public health interventions across various regions in Ghana and other African countries. Evidence from previous studies underscores the importance of community-based interventions in improving knowledge, shifting health behaviours, and strengthening disease control mechanisms [38, 48–52]. These findings reinforce the value of integrating AMR education and surveillance within community structures as a sustainable strategy for curbing resistance and promoting antimicrobial stewardship.

Policy implications

The study identifies a crucial role that communities can play in antimicrobial resistance awareness and stewardship in Ghanaian communities. It suggests incorporation of measures on drug acquisition, regulation, sensitization and education into national policies regarding antimicrobial use. Per the findings of this study, this may include context/area-specific interventions regarding AMR awareness, antimicrobial use and stewardship. The study also hints at the importance of formal education in making populations better equipped in the fight against AMR. This is also a factor worth-consideration in AMR policy implementation.

Limitations

There were a few limitations in this study that are worth noting. As a result of funding constraints, we were unable to extend community engagement to broader settings such as churches, markets, and pharmacies, thus potentially leading to a larger sample size. Also, we relied on self-reported data, which could potentially lead to reporting bias, as the study participants may have misrepresented their antibiotic use or knowledge due to recall bias or social desirability. To strengthen future research, a larger and more inclusive sample should be pursued, alongside complementary observational methods, such as monitoring pharmacy sales, evaluating household antibiotic storage, and incorporating digital health to validate self-reported data and improve accuracy. Nonetheless, the insights generated remain a valuable contribution to AMR efforts and reflect meaningful patterns within the study areas.

Conclusion

This pre- and post-engagement study, conducted during World Antimicrobial Awareness Week 2024 across diverse rural, peri-urban, and urban communities in Ghana, reveals persistent misconceptions and informal drug acquisition pathways that fuel antimicrobial resistance (AMR). Significant knowledge gaps are highlighted by baseline data, such as the common misconception that antibiotics cure viral diseases, the high self-reported ease of access outside of professional treatment, and the frequent use of antibiotics in animal husbandry. Targeted community sensitization through in-person educational activities, on the other hand, proved to be very successful in achieving universal awareness of antibiotics and AMR, significantly increased confidence, more accurate conceptual understanding, and nearly full recognition of misuse and its implications for public health. Notwithstanding, generalization of the findings of the study is limited by its relatively smaller sample size and convenient sampling methods.

These findings highlight the promising effect of quick, context-appropriate community involvement as a scalable tactic to quickly increase AMR knowledge and encourage safe antibiotic use in settings with limited resources. To reduce the increasing threat of resistance in Ghana and other low- and middle-income countries, such interventions must be incorporated into national AMR action plans along with stricter regulations and One Health strategies.

Abbreviations

AMR

Antimicrobial resistance

LMICs

Low- and middle-income countries

WAAW

World AMR Awareness Week

WHO

World Health Organization

PA

Physician Assistant

MLS

Medical Laboratory Scientist

VOSViewer

Visualization of Similarities Viewer

Authors’ contributions

ADL, CWA, MNA conceptualized the study, led the methodology design, supervised data collection, and drafted the manuscript. MNA, JD, CKA, PAB, SN, SK, MKN, MO, CATA, RMD, VS, AOB, NEAA, SM, BA, JA, MKQ, SEB, and WE contributed to data collection, community engagement, and preliminary analysis.JM, DD, SB, and NK provided technical guidance, supported interpretation of findings, and critically reviewed the manuscript. CWA coordinated the project, secured ethical approval, validated data, and served as the corresponding author. All authors read and approved the final manuscript.

Funding

The WAAW celebration was funded by the South Centre of International Environment House 2, Chemin de Balexert 7–9 1219 Vernier, Switzerland.

Data availability

Datasets derived from the administered questionnaires and those analysed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate was obtained from the Committee on Human Research, Publications and Ethics (CHRPE), School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana, as part of the ongoing Expand AMR project (approval number CHRPE/AP/094/23). All procedures performed in this study were in line with the ethical standards of the CHRPE and with the Helsinki declaration. All participants signed informed consent for their participation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.